Clinical Course of Diabetes After Gastrectomy According to Type of Reconstruction in Patients with Concurrent Gastric Cancer and Type 2 Diabetes

Zhu, Zhenxin; Shan, Xiaodong; Cheng, Yajun; Xu, Jiapeng; Fu, Hongbing; Wang, Weimin; Yan, Ran; Cai, Qing-Qing

doi:10.1007/s11695-014-1426-4

Cited by 18 publications

(17 citation statements)

References 29 publications

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“…In the current study, Roux-en-Y procedure exerted a more effective function in stabilizing plasma glucose level than FJI reconstruction in OGTT test, and this effect was more significant at 6 and 12 months than 3 months after surgery. In the surgical treatment for concurrent gastric cancer and type 2 diabetes, it has been proved that among various surgical procedures total gastrectomy with Roux-en-Y reconstruction was associated with the highest remission rate [24]. Although patients with diabetes preoperatively were excluded in this investigation, we have also revealed that Roux-en-Y esophagojejunostomy exhibited the superiority over FJI reconstruction in improving glucose metabolism after the challenge of glucose intake.…”

Section: Functional Outcome Jejunal Interposition 247mentioning

confidence: 69%

“…Another research published in recent years has proved that total gastrectomy could improve the glucose metabolism in gastric cancer patients [22]. In addition, the reconstruction type following gastrectomy is associated closely with postoperative remission rate of diabetes in patients with concurrent gastric cancer and diabetes mellitus [23,24]. Several hormones secreted in the digestive tract have been demonstrated to participate in the regulation of glucose metabolism after the gastrectomy and reconstruction.…”

Section: Functional Outcome Jejunal Interposition 247mentioning

confidence: 99%

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Comparison of Functional Outcomes between Functional Jejunal Interposition and Conventional Roux-en-Y Esophagojejunostomy after Total Gastrectomy for Gastric Cancer

Jiang

Peng

et al. 2019

Dig Surg

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Background: The reconstruction of digestive tract after total gastrectomy is associated with various postoperative complications. We aimed to investigate the differences in functional outcomes of 2 reconstruction techniques following total gastrectomy: functional jejunal interposition (FJI) versus Roux-en-Y esophagojejunostomy. Methods: Sixty patients were enrolled and divided into FJI and Roux-en-Y groups. Nutritional parameters and incidences of reconstruction-related symptoms were evaluated. Oral glucose tolerance test and endoscopy examination were carried out. Results: The postoperative prognostic nutritional index scores and postoperative/preoperative body weight, meal intake, serum albumin level ratio were significantly higher in the FJI group than in the Roux-en-Y group. At 3, 6, and 12 months postoperatively, the elevations of plasma glucose level after glucose intake were more significant in the FJI group than in the Roux-en-Y group. The incidence of post-operative stasis symptoms in the Roux-en-Y group was significantly higher than in the FJI group, but no obvious difference was observed regarding dumping and reflux symptoms. The incidence rates of severe esophageal mucosa injury and severe anastomotic stricture were also similar between the 2 groups. Conclusion: FJI reconstruction might accelerate the recovery of nutritional status and reduce the occurrence of stasis symptoms postoperatively as compared with Roux-en-Y esophagojejunostomy, which may have an advantage over FJI in stabilizing body glycometabolism after surgery. These 2 types of reconstruction may have a similar anti-reflux function to prevent severe reflux esophagitis and anastomotic stenosis.

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Section: Functional Outcome Jejunal Interposition 247mentioning

confidence: 69%

Section: Functional Outcome Jejunal Interposition 247mentioning

confidence: 99%

Comparison of Functional Outcomes between Functional Jejunal Interposition and Conventional Roux-en-Y Esophagojejunostomy after Total Gastrectomy for Gastric Cancer

Jiang

Peng

et al. 2019

Dig Surg

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“…Patients with concurrent gastric cancer and diabetes can exhibit remission of diabetes after gastrectomy. 22,23 It was thought that gastrectomy is not just a tumor resection surgery, but also an onco-metabolic surgery. However, patients with concurrent gastric cancer and hypertension after gastrectomy have rarely been reported.…”

Section: Discussionmentioning

confidence: 99%

<p>Onco-Metabolic Surgery: A Combined Approach to Gastric Cancer and Hypertension</p>

Peng¹,

Cheng²,

Tao³

et al. 2020

CMAR

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The purpose of this study was to explore the changes in blood pressure in patients with concurrent gastric cancer and hypertension after gastrectomy, and to identify the factors that affect the changes in blood pressure. Materials and Methods: Patients with concurrent gastric cancer and hypertension who underwent gastrectomy were retrospectively analyzed from January 2013 to December 2018. The pre-and 6-month postoperative medical records were compared. Predictors for the remission of hypertension were analyzed. Results: A total of 143 patients with concurrent gastric cancer and hypertension were included in this study. The number of patients with complete remission, partial remission and no remission were 67 (46.9%), 12 (8.4%) and 64 (44.7%), respectively. The average of weight and BMI (body mass index) before gastrectomy were 63.0 ± 9.7 kg and 23.4 ± 2.9 kg/ m 2 , respectively, which were significantly higher than those 6-month postgastrectomy: 54.8 ± 9.8 kg and 20.4 ± 3.1 kg/m 2 , respectively (p<0.001). The average number of antihypertensive medications before gastrectomy was 1.5 ± 0.6, while it was 0.8 ± 0.8 6-month postgastrectomy (p<0.001). Age (p<0.05) and the surgical techniques used (p<0.05) were significantly different between partial remission and no remission patients. Furthermore, age (p<0.05) and the surgical techniques used (p<0.05) were significantly different between complete remission and no remission patients. Age (p<0.05, odds ratio =0.933, 95% CI=0.890-0.978) and the surgical techniques used (p<0.05, odds ratio =2.749, 95% CI=1.132-6.677) are predictors for remission of hypertension. Conclusion: Total gastrectomy is an onco-metabolic surgery that can cure younger patients with concurrent gastric cancer and hypertension. Age and the surgical techniques used can predict the remission of hypertension 6 months after gastrectomy.

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“…Conference abstracts, case report, studies without comparison of surgical methods, a follow-up time less than 1 year, and repeated published data from the same center were excluded. The remaining nine studies [13][14][15][16][20][21][22][23][24] were included in the meta-analysis ( Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…Previous literature on factors which affect T2DM remission is controversial. Many studies reported that total gastrectomy combined with R-Y was the key factor for postoperative remission of T2DM [14,15]. Some studies reported that the extent of gastrectomy was the cause of T2DM remission; however, other studies reported that the R-Y was the main reason for the remission of T2DM [16].…”

Section: Introductionmentioning

confidence: 99%

Does Roux-en-Y Construction Really Bring Benefit of Type 2 Diabetes Mellitus Remission After Gastrectomy in Patients with Gastric Cancer? A Systematic Review and Meta-Analysis

2020

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Introduction: To evaluate whether the extent of gastrectomy or the reconstruction method brings benefit of type 2 diabetes mellitus (T2DM) remission after gastrectomy in patients with gastric cancer. Methods: PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched to find eligible studies published from inception to July 31, 2020. Results: A total of nine studies (1424 patients) were included. At the first year and the end of follow-up time after gastrectomy, the total gastrectomy group had better T2DM remission than the subtotal gastrectomy group, and the Roux-en-Y reconstruction (R-Y) group had better T2DM remission compared with the non-R-Y group. There was no difference between R-Y and non-R-Y in terms of subtotal gastrectomy (OR 1.08, 95% CI 0.63-1.84, P = 0.78). However, total gastrectomy with R-Y had better T2DM remission than subtotal gastrectomy with R-Y (OR 2.75, 95% CI 1.19-6.35, P = 0.02). Conclusion: Total gastrectomy with R-Y had better T2DM remission. The extent of gastrectomy rather than the reconstruction method might play an important role in T2DM remission after gastrectomy in patients with gastric cancer.

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Clinical Course of Diabetes After Gastrectomy According to Type of Reconstruction in Patients with Concurrent Gastric Cancer and Type 2 Diabetes

Cited by 18 publications

References 29 publications

Comparison of Functional Outcomes between Functional Jejunal Interposition and Conventional Roux-en-Y Esophagojejunostomy after Total Gastrectomy for Gastric Cancer

Comparison of Functional Outcomes between Functional Jejunal Interposition and Conventional Roux-en-Y Esophagojejunostomy after Total Gastrectomy for Gastric Cancer

<p>Onco-Metabolic Surgery: A Combined Approach to Gastric Cancer and Hypertension</p>

Does Roux-en-Y Construction Really Bring Benefit of Type 2 Diabetes Mellitus Remission After Gastrectomy in Patients with Gastric Cancer? A Systematic Review and Meta-Analysis

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